H&HN Daily

A Checklist That's Just For Patients

05.24.12 by Haydn Bush

Kaiser Permanente develops a safety checklist for use by patients instead of clinicians.

NATIONAL HARBOR, M.D. — There I was, a confused 8-year old with a rash and a headache. My worried mother discussed my condition with an attentive physician, who asked her about my symptoms, their duration, and possible related events in the last week. The physician then asked me to describe the rash and my overall state of mind. I told him I just felt a little weird.

This isn't a painful childhood memory, though; it was an interesting role-playing scenario during the opening session of the National Patient Safety Foundation's 2012 Congress. This morning, clinicians from Kaiser Permanente invited audience members to test out a new safety checklist under development at the California health system.

Checklists are nothing new, of course, but Kaiser Permanente's list would be strictly for patient use, with instructions to assess their medical condition, discuss symptoms, medical history and diagnosis with their doctor and ensure that they understand what next steps are needed.

The so-called SMART list — Symptoms, Medical/medication history, Assessment, Review and To Do — is designed to help patients and their families better navigate confusing, harried interactions with providers, said Doug Bonacum, vice president of quality, safety and resource management at Kaiser Permanente.

"The intent is to communicate to patients and families that their voice is important," he added.

Bonacum and other Kaiser clinicians play-acted a version of the above scenario without the checklist, before asking us to try it out ourselves, and then returning to the stage to simulate proper use of the checklist. All of the interactions were supposed to take place in hectic EDs with harried physicians bouncing back and forth between patients — but in the second version, the clinicians listened carefully to a pair of audience members who used the checklist to convey the 8-year-old's condition. In the first scenario, the boy was misdiagnosed with a cold; using the checklist, the clinicians determined a far more serious diagnosis of meningitis.

The reaction from the audience was mixed. Many of the attendees said they felt tongue-tied by the reverse-role playing and thought the list would be a useful tool for focusing their attention on both their condition and what next steps were appropriate.

"I've been using checklists for 30 years," said one attendee, a pilot who's attending the meeting for ongoing training. "But my brain turned to mush (during the exercise) thinking of my son."

Another attendee, a physician, said he wasn't sure the checklist would work for all patients.

"I have some cynicism of the utility of the tool," he said. "Some patients are more assertive, but there are those who are not assertive. It can take a lot for patients to speak up given the dynamics."

Nevertheless, the informal consensus was that the nature of the tool — which requires patients to both communicate with their doctors while self-assessing their condition and paying closer attention to their own tasks in their care journey — would be helpful.

And in an informal quick poll of the audience, 95 percent of attendees said the misdiagnosis in the first scenario could occur in their institutions, while 58 percent of attendees said their organization was working a strategy for patient/provider communication.

As the nation’s health care system transitions to more integrated and patient-centered care, hospitals are utilizing information technology to better connect disparate care providers, according to the 16th annual Health Care’s Most Wired Survey, conducted by Hospitals & Health Networks.

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